In an effort to reduce patient care complications related to resident physician fatigue the ACGME has imposed work hour restrictions on a national level to limit the number of hours resident physicians can work. Although work hour restrictions are quite detailed in general most residents are currently limited to an 80 hour work week and shifts less than 24 hours.
Resident based medical institutions (more than 9,000 in the US) which are governed by the ACGME must therefore track and document resident work hours. Despite this regulation, work hour limits continue to be violated for many reasons. When the ACGME discovers that a residency program is violating work hour regulations that institution is subject to strict penalties including fines and probation or suspension.
Currently work hour restrictions are not adequately enforced and residents continue to work beyond their limits while jeopardizing patient care. The reasons for work hour violations are multiple but include inadequate man power, continuation of previous culture where residents worked unlimited hours without rest, abuse of power by superiors, blind neglect by superiors to enforce hours, inadequate infrastructure to enforce hours. Frequently, resident violation of work hour restrictions are self-imposed out of loyalty to the team or a sense that he/she is letting the team down by going home to rest.
Regardless of the reason that work hours are violated it is a fact that work hour violations continue at the expense of the resident but even more importantly at the expense of the patient. Currently our extensive survey indicates that institutions utilize suboptimal methods to track, monitor and report work hours. To the best of our knowledge and after exhaustive research we have yet to encounter a system for tracking resident work hours that does not rely on resident physician self-reporting. Current methods include self-reporting by way of web based applications, smart phone applications, surveys, paper documentation and many other methods. No system to date uses objective or passive methods to collect this data. These methods that require active resident participation to log hours are inherently flawed for multiple reasons. Residents are reluctant to report hours and when they do they feel pressure to report hours that conform with work hour restrictions. Residents that were interviewed expressed worries about being viewed as weak and having repercussions from seniors. They were concerned that the reporting of work hour overages may lead to suspension of their program with resulting collateral damage to their training. Additionally subjective reporting is by nature inaccurate as the data is not logged in real time and residents may forget or accidentally document hours that are inaccurate. Residents are already very busy and it is hard to perform the daily task of logging hours.
Accordingly, a system is needed to objectively, passively (resident is not required to self-report hours) and accurately track, monitor and not only report resident work hour statistics but also aid in the correction of those violations. Furthermore, the same system can be used to serve other functions in the work place. Including applications to track the time spent by different users in the hospital setting including time spent by users at various locations in the hospital and clinical setting for the purpose of capturing metrics including time spent with patients and at various locations in the hospital for the purpose of improving coordination of care and also for billing purposes.